Foot Deformities in Children with Cerebral Palsy: An Overview

Abstract

One of the most common musculoskeletal impairments in children with cerebral palsy (CP) is related to deformities of the feet. These deformities are almost immediately obvious when the child starts to walk. Typically the child starts with toe walking often with underlying planovalgus foot deformity. This deformity becomes an immediate focus to family members and caregivers as the cause of the limited walking ability. The concerns around the feet are often managed in the young child with the prescription of orthotics, physical therapy, and the use of assistive walking devices. As the child grows through early childhood and into middle childhood, the foot deformities often improve. However, during late childhood and adolescences, deformities typically increase and become more symptomatic. During this time in adolescence, surgical corrections are often required. Lengthening of the plantar flexors is typically required around age 6–9 years. Correction of the varus component of equinovarus is not recommended until after age 8 years because of a high risk of overcorrection. Surgical correction of planovalgus is most reliable when the child has entered the adolescent growth period. Planovalgus correction may include calcaneal lengthening for milder deformities in children with good ambulatory ability. Subtalar fusion is recommended for feet with severe deformities and patients who have limited ability to walk. The goal of this chapter is to provide an overview of the deformities which occur in children with cerebral palsy.